PRN medications

[Christy]

My son is currently in a physchiatric hospital to get his medications stabilized. During this time (8 LONG days and counting) he has been given PRN medication either by mouth or injection (ativan and more often zypraxia) when he is having a violent meltdown. While the goal is to become satablized thus eliminating the need for PRN medication, I am wondering if doctors ever prescribe PRN's for parents to use. I hope that when he is out, he will not need them but we have been at this long enough to know that no medication cocktail works forever on a growing difficult child. I am thinking that if I had access to a PRN medication, I might be able to work with him on an outpatient or partial hospitalization level. I know he needs help but I HATE the prison-like environment of the psychiatric hospital and want my little guy home. Anyone have experience giving PRNs?

Thanks,
Christy

 

[smallworld]

We have used Risperdal, Zyprexa and Klonopin over the years for PRNs. All come in tablets that melt quickly on the tongue.

I hope the psychiatric hospital is looking closely at your difficult child's medications. Strattera can easily destabilize a child with BiPolar (BP). He's also not on a first-line mood stabilizer (Lithium, Lamictal, Depakote, Tegretol, Trileptal). Those should stabilize him more over the long haul than atypical antipsychotics (Seroquel, Geodon).

You might want to take a look at the BiPolar (BP) treatment guidelines http://www.thebalancedmind.org/sites/default/files/treatment_guidelines.pdf Good luck.

 

[slsh]

Hi Christy,

We did use prns when thank you was 8 and 9. Thorazine prn raging. Good concept in theory, lousy in practice. Trying to get a raging kid to take a pill is probably about as easy as giving a cat a bubble bath. I was not terribly proactive in terms of getting the medication into him before he hit mach-5 though. I really didn't like the thought of prns at the time - my thinking has changed.

I know some folks have been able to use prns fairly successfully (seroquel comes to mind with one family). I don't think it's a real common practice, but I think it's certainly worth talking to your psychiatrist about.

Hope they're able to get those medications tweaked quickly and he's home soon.

 

[Christy]

Sorry. I have not updated my signature. Yes, I agree 100% about the straterra. He started taking it about 3 months ago because of extreme ADHD like symptoms that now looking back was probably the beginning of mania. He did pretty well and was at 40 mg and the psychiatrist increased it to 50 mg. Unfortunately, we did not put two and two together and now realize that it was probably the extra 10 that but him over the top with agression. We shared this with the hospital and asked that strattera be eliminated. The dose was initially lowered and I asked two days ago again to eliminate it. As for mood stabalizers, the doctor there is trying trileptal. he has been on risperdal and lamictal (the combo worked for about 2 years and then stopped being effective even with an increased dose). Next we went through depakote and abilify, not much success with abilify and depakote did no good even after finally reaching a theraputic level. Geodon did remarkably well for about 6 months and no longer seems to be cutting it.

By the way, I love the "giving a bubblebath to a cat analogy--sounds like something my difficult child would try-LOL.

Thanks for your advice and sharing your experiences.
Christy

 

[sandman3]

Christy,
yeah, I have Risperdal PRN for my difficult child 1, but like the cat in the bubblebath, once he's raging it's WAY too late! He thinks I'm trying to poison him or something when I try to get a medication in his mouth when he's ticked off at the world!

Good luck!

 

[susiestar]

We used prn medications with a fair amount of success. I think we had more luck because I would have a dose ground up and stored - then I just mixed it in a little hershey's syrup and poked it in him. Harder as he got older, but it did help.

I think the choc syrup (or jam, or peanut butter) really helped.

One thing to be aware of: some medications have to be in the system for weeks or months to see the full effects on an illness. And some medications have to be in the system for weeks or months to see all the side effects. Zoloft was this way for my son. It may not have been the extra 10mgs of strattera, it could jsut have been the strattera.

SOme kids/people with bipolar need 2 mood stabilizers, and an antipsychotic to be stable. It would be worth asking about.

Hugs and prayers,

Susie